Preventing Workers’ Comp Claim Fraud

Workers’ compensation is one of the most useful tools at a business’s disposal. It protects the employees from illness and injury, provides for them after accidents and defends the business against lawsuits and liability. However, there are dishonest people out there who will try to use workers’ comp to their own advantage by abusing the system and committing fraud. Here are some ways to avoid workers’ comp claim fraud.

Educate Your Workers

Sit your staff down and have a workshop about workers’ compensation coverage. Explain to your workers exactly what it is and how it works. State in no uncertain terms that you have a zero tolerance policy regarding fraudulent claims. Posters and newsletters can be excellent tools that spotlight how serious a crime insurance fraud is. Establish an anonymous means by which your workers can report fraud and make it known.

Implement a Safety Program

Hand-in-hand with worker education is safety training. Hold regular safety meetings, be it monthly, bi-monthly or quarterly. At these meetings go over rules, regulations and procedures for handling dangerous situations or incidents. Use posters and newsletters to reinforce these procedures. The safer your workplace is, the fewer claims you will have in general and the easier it will be to spot fakes.

Background Checks

As onerous as the process may seem, background checks are a good idea in today’s environment. Make sure that you are hiring the most reliable and vetted staff possible. A background check on an otherwise solid-appearing potential hire can unveil several past fraudulent claims or convictions.

Enact Monitoring Policies

Avoid potential fraud situations by monitoring your employees’ activities. Installing monitoring cameras or having strategies like the buddy system wherein more than one staff member is present at all times can go a long way towards minimizing false claims.

Maintain Solid Policies

It is vital to have a solid and reliable policy of dealing with injuries and accidents. You should have a staff member who is in charge of the entire process. This person should be well-trained in the rules, regulations and laws surrounding workers’ compensation. They should be able to:

Recommend your preferred medical provider

Take down the details of the incident

Interview witnesses

Preserve any evidence

Get the information to the administrator immediately.

Know the Signs

There are certain red flags that you can watch for to catch a potential fraudster. While these flags are not necessarily incriminatory unto themselves, they are things which may be indicators of potential fraud. These warning signs include:

Job hopping or uncertain work history

Workers with a lien for child support or alimony

Employees with a long criminal record

Providing exaggerated or overly detailed incident reports

Skepticism from co-workers about the claim’s validity

The Back-to-Work Plan

Keep in contact with your injured workers. Have a solid plan for their return to duties. Be willing to offer modified, alternative or temporary duties that allow them to come back to the workplace while working on their healing. This will make them feel valued, and will eliminate the temptation to use workers’ comp to get out of working.

Do you have any ideas about minimizing insurance fraud in the workplace? Leave us a comment and start a discussion on the issue.